Project Summary/Abstract Candidate: Dr. Bernstein is Assistant Professor of Medicine in the Division of Rheumatology at Columbia University. She is a clinical investigator with 12 total and 7 first-author original research publications, previous funding from the Arthritis Foundation and a KL2, and current funding from the Rheumatology Research Foundation. She has a Master?s Degree in Clinical and Translational Investigation. Her long-term career goal is to become an independent investigator in rheumatology who leads both clinical and epidemiological investigations of early interstitial lung disease (ILD) in systemic sclerosis (SSc), and who develops and tests interventions for the prevention of ILD in SSc. Career Development Plan: Dr. Bernstein and her mentors have crafted a career development plan intended to lead to independence by the end of the K23 award period, including training in advanced epidemiological methods and statistical modeling, qualitative and quantitative lung imaging, and clinical trials and multicenter studies. These new skills and knowledge will allow Dr. Bernstein to pursue a career as an independent clinical and epidemiologic investigator focused on prevention of ILD in SSc, and to submit a competitive R01 application during the fourth year of the K23. Environment: Dr. Bernstein has the protected time, facilities, resources, and expert support of the Department of Medicine to accomplish the mentored research and career development activities outlined in the K23. The Department of Medicine and Division of Rheumatology have guaranteed at least 75% protected time to devote to research and career development. She has regular opportunities for intellectual interactions with other investigators, including the opportunity to attend and present at a large number of recurring conferences and seminars relevant to her area of research. She will also engage in relevant coursework at the Columbia University Mailman School of Public Health. Research: Under the guidance of her expert mentorship team, led by Drs. David Lederer and Joan Bathon, Dr. Bernstein will perform a two-center prospective cohort study of 220 newly referred adults with SSc to achieve her Aims. The central hypothesis of this study is that screen-detected ILD in SSc is both biologically and clinically relevant, despite the absence of symptoms, because it (1) is associated with biomarkers of ILD and (2) precedes the onset of clinical symptoms and functional limitation and may therefore represent a ?window of opportunity? for intervention. In Aim 1, Dr. Bernstein will conduct a cross-sectional study to establish the prevalence, clinical features, and biomarker profile of screen-detected ILD in SSc. In Aim 2, she will perform a longitudinal study to examine the progression of screen-detected ILD in SSc. Performing this K23 mentored research and obtaining training in advanced epidemiological methods and statistical modeling, qualitative and quantitative lung imaging, and clinical trials and multicenter studies will position her to become a successful independent investigator.